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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3059 — Patient’s Perceptions of the Acceptability, Risks, and Benefits of Dementia Screening

Author List:
Holsinger TC (Center for Health Services Research in Primary Care, Durham VAMC)
Williams JW (Center for Health Services Research in Primary Care, Durham VAMC)

Objectives:
The USPSTF found insufficient evidence to recommend dementia screening, in part due to little information on its risks and benefits. We evaluated the acceptability, perceived risks, and benefits of dementia screening among mid-life veterans.

Methods:
We enrolled a consecutive sample of veterans, aged 50-64 years old attending a primary care appointment. Veterans completed the 58-item Modified Screening Acceptance and Perceived Harms questionnaire, which asks about the acceptability of different screening methods, and perceived impact on emotional health, the family, future planning, medical care, insurance coverage, and institutionalization. After considering risks and benefits, acceptability was reassessed. We used chi-square and t-tests to compare acceptability to patient characteristics and perceived risks/benefits.

Results:
Of 143 eligible veterans approached, 118 (83%) agreed to participate. Participants were on average 58 + 4.6 years old, and had 14 + 2.3 years of education. Racial breakdown was 56% white and 39% black; 90% were men. Most (51%) knew a friend or relative with dementia and 32% thought they were at higher risk for dementia than others their age. Veterans overwhelmingly wanted to know if they were developing dementia (92%; 95% CI 87% to 97%) or a problem with memory (93%; 89% to 98%). Acceptability did not vary significantly by demographic characteristics or perceived risks and benefits. A brief questionnaire was the most accepted screening form (89%); blood testing (84%) and imaging (75%) were less acceptable (p=0.02). Perceived benefits included improved planning for their future (87%) and the chance for improved treatment (83%) although 54% did not know if treatment for dementia was available. Of the 58% of subjects without an advance directive, 82% intended to complete one if diagnosed with early dementia. Perceived harms included: adverse emotional (79%) or financial (42%) effects on the family; loss of driver's license (75%); feeling depressed (57%) or anxious (47%); negative effects on their ability to get long-term care insurance (39%); and nursing home placement (26%). When acceptability was reassessed, 96% wanted dementia screening; simple agreement (92%) and chance corrected agreement (phi=0.65) indicate high test re-test reliability.

Implications:
Dementia screening is highly acceptable to veterans despite uncertainty about treatment options and a large number of perceived harms.

Impacts:
By the year 2025, almost 20% of the population is predicted to be over the age of 65 and the prevalence of dementia is expected to increase proportionately. Because questionnaires are acceptable and relatively inexpensive, we should prioritize identification of dementia-screening instruments that are valid in veteran populations.


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